Purpose of Review <p>This review aims to provide a comprehensive comparison between acute retinal necrosis (ARN) and progressive outer retinal necrosis (PORN), two sight-threatening manifestations of herpetic viral retinopathies emphasizing how immune status shapes presentation, diagnosis, management, and prognosis.</p> Recent Findings <p>Recent studies suggest that ARN and PORN represent a spectrum influenced largely by host immune status rather than distinct diseases. Ultra-widefield imaging improves detection of far-peripheral lesions, while PCR of aqueous or vitreous enables rapid etiologic confirmation. In ARN, high-bioavailability oral antivirals, often with adjunct intravitreal injections, accelerate lesion regression and reduce fellow-eye involvement. In PORN, monotherapy performs poorly; combined intensive intravitreal and systemic therapy improves local control but vision remains limited in advanced immunosuppression.</p> Summary <p> Prompt differentiation based on inflammatory signs, lesion morphology, and host immunity directs therapy. ARN generally responds to systemic agents yet carries substantial detachment risk; PORN progresses quickly with worse outcomes despite aggressive care. Early diagnosis coordinated medical–surgical management, and close surveillance are critical; priorities include optimal dosing and duration of antiviral therapies as well as adjunctive anti-inflammatory strategies.</p>